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Behaviour Research and Therapy
Volume 44, Issue 3, March 2006, Pages 371-394
 
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doi:10.1016/j.brat.2005.03.005    How to Cite or Link Using DOI (Opens New Window)
Copyright © 2005 Elsevier Ltd All rights reserved.

Solving the puzzle of deliberate self-harm: The experiential avoidance model

Alexander L. Chapmana, Corresponding Author Contact Information, E-mail The Corresponding Author, Kim L. Gratzb, E-mail The Corresponding Author and Milton Z. Browna, c, E-mail The Corresponding Author

aDepartment of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA bCenter for the Treatment of Borderline Personality Disorder, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA cAlliant International University, 10455 Pomerado Road, San Diego, California 92131-1799, USA

Received 10 September 2004; 
revised 28 February 2005; 
accepted 16 March 2005. 
Available online 4 May 2005.

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Abstract

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework—the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.

Keywords: Self-harm; Self-injury; Self-mutilation; Experiential avoidance; Emotion; Emotion regulation

Article Outline

The puzzle of deliberate self-harm behavior
Solving the puzzle of deliberate self-harm: the experiential avoidance model
General tendency to avoid or escape from aversive emotional experiences
Factors that may underlie heightened experiential avoidance tendencies
The function of DSH: escape or relief from emotions
Self-report studies of emotional antecedents and consequences of DSH
Self-report studies on the perceived function of DSH
Psychophysiological studies relevant to the function of DSH
Mechanisms of emotional escape in DSH
The opioid hypothesis
Distraction
The self-punishment hypothesis
The vicious cycle of experiential avoidance and DSH
Paradoxical effects of experiential avoidance
Failure of extinction and emotional processing
Rule governed behavior
Habituation of reactions to negative consequences over repeated trials
General summary and discussion
Further Reading
References


 
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